Medical Call Centers: Building Versus Outsourcing

By Ken Bleakley

Medical professionals and others who identify a need for health information services in their communities may be in an ideal position to build a thriving business. One of the biggest challenges faced by nurse triage call centers is building a large enough client base to support investment in infrastructure, operations, and accreditation for quality assurance. Modern communications technology and the Internet now make flexible, scalable solutions possible.

An organization with even a small potential client base can begin by branding services in its name and outsourcing them to an accredited 24/7 health information call center. As the business builds, the organization can recruit its own nurses and use a hosted health information system over the Internet to provide limited operations while continuing to outsource selective functions. If the business grows large enough, the organization can migrate to its own call center.

Approaches to Providing Health Information Services: Healthcare organizations have three basic choices regarding the provision of call center services. These choices are briefly summarized as follows:

1) Build a Medical Call Center: This is usually the first choice for large organizations because they view a proprietary facility as less costly than outsourcing, more easily customized to their particular needs, and more reliable because it is under their direct control. These assumptions are not always true, and some installed systems are now closing down. Problems include: an inadequate supply of nurses trained in call center operations; reliance on bundled technology or legacy operating systems; lack of understanding and flexibility regarding the multitude of applications and media available to access them; and a lack of knowledge and experience regarding how to install and operate a modern health information center. In general, a minimum of 6000-8000 triage calls per month are required to sustain a viable 24/7 medical call center.

Where such an approach makes the most sense, look for an industry leader in integrating the best technology available into a state-of-the-art health information center. An organization will need a health information operating system with pediatric and adult protocols, installation, training, and support at its site. It should also be possible to customize or add specialized protocols as needed. Specific things to look for include:

  • Reliable and easy to use software, designed by medical doctors and registered nurses with reliability and ease of use as their goals
  • Programming that allows for quick links to client databases, online scheduling applications, and community and national resources
  • Ready to integrate with EMR (electronic medical record) systems as they evolve
  • Fully-integrated, widely-respected office or after-hours medical protocols
  • Licensee’s system administrators should be able easily to customize the call flow and visible screen elements to make the triage process as efficient as possible for triagers
  • Licensee’s operations administrators should be able to customize client information by group and sub-group, allowing triage staff to provide personalized service to an infinite number of clients
  • It may be desirable for the software vendor to provide backup, overflow capacity, and specialized programs when needed.

2) Outsource: In many cases outsourcing may be a more effective approach, at least initially. The healthcare organization needs to be able to contract for the services required by each of its entities, experiment with different types of services, and analyze the costs and benefits of each — without a large capital outlay or commitment to particular technology and infrastructure.

The healthcare professionals and management operating the center should be recruited and trained for this specialized function to provide the peace of mind that clients are looking for.  Individual encounter and aggregated reports should be provided as an effective quality and cost control to the sponsoring organization. The service should also be transparent to the end-user in the event that clients are branding the service in their own names.

When shopping around for after-hours nurse triage, be sure to ask vendors these questions:

  • Is this service accredited by a recognized national or state agency?
  • Do they use unassailable medical protocols?
  • Is all triaging performed only by registered nurses with extensive experience?
  • Do they have a comprehensive orientation program and maintain a continuous quality improvement program?
  • Do they indemnify against their errors and omissions and carry adequate malpractice insurance?
  • Are calls recorded and individual encounter reports dispatched immediately upon call completion?
  • Does the service provide an authoritative point of contact and follow-up on all calls?
  • Is this an unsubsidized service without strings?
  • Is the service charge sustainable and all-inclusive (i.e. not a “teaser” rate)?
  • Can they provide multiple references from similar organizations?
  • Will their operating system facilitate practice-specific responses to callers?
  • Do they have 24/7 coverage?
  • Are nurses on standby for surges?

3) Hosted or Hybrid Systems: Organizations with 3000-8000 nurse triage calls per month might wish to consider hosted or managed systems that facilitate their qualified nurses logging onto a health information center operating system remotely. These are sometimes described as “software as a service” by access services providers. They have all the functionality of an installed system without the need for servers, systems administrators, and extensive infrastructure. The organization can operate its own facility but outsource certain functions, for example: coverage on slow shifts and overflow periods; foreign language service; and specialized programs.

Features to look for include:

  • The host provides all server hardware.
  • Licensee accesses the health information operating system via a standard Internet browser.
  • The host customizes the software for the licensee on both the developer and administrative levels.
  • The host can provide more extensive management functions and develop custom programs for the operating system if desired.
  • Users should be able to access the application from a call center environment or from their homes, substantially reducing overhead.

The Partnership for Success: Medical professionals and others who identify a need for health information services in their communities need to look closely at the specific opportunities in their target market. These may include services to employers, insurers, governments, and HMOs. Likewise, the service may be directed primarily at after-hours calls for physicians on a per-call basis.

After identifying their requirements, they should be able to ask in-depth questions such as those above of prospective providers. Their providers should be able to assist them in developing a realistic business model that identifies marketing strategies, potential call volume, costs, and return on investment. The best arrangements will be those in which the provider and the medical call center operator have a shared interest in the success of the venture and develop the close working relationship necessary to secure that success.

Ken Bleakley is the CEO of Fonemed — a URAC accredited company supplying installed and hosted medical call center systems and its own nurse advice line services. Contact them at or call 800-366-3633.

[From the February/March 2009 issue of AnswerStat magazine]